Individual provider Active NPI

Kirsten Alexis Fontenot, MD

  • Pediatrics Physician
  • York, PA
National Provider Identifier
1669050878
Registry record updated Apr 14, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
MD483468 Issued in PA
Practice address
2675 Joppa Rd
York, PA 17403-5160
Phone
(717) 741-9063
Fax
(717) 718-9779
NPI assigned
Mar 30, 2021
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Apr 14, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X
Pediatrics Physician 208000000X MD483468 PA Primary

Addresses

Primary practice location

2675 Joppa Rd
York, PA 17403-5160

Mailing address

601 Memory LN
York, PA 17402-2231
Phone (717) 851-1405

Other practice location 1

15 Constitution Ave
Shrewsbury, PA 17361-1709
Phone (717) 235-6848

Other practice location 2

100 N Academy Ave
Danville, PA 17822-9800
Phone (570) 271-5606

Other practice location 3

2050 S Queen St
York, PA 17403-4829
Phone (717) 812-4240

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240628001747 PA Practitioner - Pediatric Medicine 3274935853 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
Wellspan Medical Group Current Accepting new patients
Wellspan Medical Group CurrentSince Aug 12, 2024 Accepting new patients
Wellspan Medical Group CurrentSince Aug 12, 2024 Accepting new patients

Locations

15 Constitution Ave
Shrewsbury, PA 17361
Phone (717) 227-0222

25 Monument Rd
Ste 270
York, PA 17403
Phone (717) 741-8250

601 Memory Ln
York, PA 17402
Phone (717) 851-6670

2675 Joppa Rd
York, PA 17403
Phone (717) 741-9063

1600 S George St
York, PA 17403
Phone (717) 848-3615

2050 S Queen St
York, PA 17403
Phone (717) 812-2316

Interoperability endpoints

  • Direct secure messaging: kfontenot416258@wellspan.direct-ci.com

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1617062400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1744588800000",
    "number": "1669050878",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "601 MEMORY LN",
            "city": "YORK",
            "state": "PA",
            "postal_code": "174022231",
            "telephone_number": "717-851-1405",
            "fax_number": "717-851-6969"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2675 JOPPA RD",
            "city": "YORK",
            "state": "PA",
            "postal_code": "174035160",
            "telephone_number": "717-741-9063",
            "fax_number": "717-718-9779"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "15 Constitution Ave",
            "address_purpose": "LOCATION",
            "city": "Shrewsbury",
            "state": "PA",
            "postal_code": "173611709",
            "country_code": "US",
            "telephone_number": "717-235-6848",
            "fax_number": "717-759-6770",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "100 N Academy Ave",
            "address_purpose": "LOCATION",
            "city": "Danville",
            "state": "PA",
            "postal_code": "178229800",
            "country_code": "US",
            "telephone_number": "570-271-5606",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2050 S Queen St",
            "address_purpose": "LOCATION",
            "city": "York",
            "state": "PA",
            "postal_code": "174034829",
            "country_code": "US",
            "telephone_number": "717-812-4240",
            "fax_number": "717-848-5520",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "FONTENOT",
        "first_name": "KIRSTEN",
        "middle_name": "ALEXIS",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2021-03-30",
        "last_updated": "2025-04-14",
        "certification_date": "2025-04-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "PA",
            "license": "MD483468",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in York, PA

Sources for this page

Verify at the official NPI Registry.